- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
- Stanford Health Care (Palo Alto, CA)
- …to identify trends and make recommendations for improvement. **Licenses and Certifications** + Nursing\ RN - Registered Nurse - State Licensure And/Or Compact ... Knowledge of medical management statistics relating to UM/CM and prior authorization process management. + Extensive knowledge...State Licensure . + CCM - Certified Case Manager preferred . **These principles apply to ALL employees:**… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... RN Case Manager **Position Summary** At...required. **Qualifications** **Required** : A Bachelor's degree or a nurse working on their degree with an RN… more
- Luke Staffing (Yigo, GU)
- …+ **Licensure:** Current, full, active, and unrestricted license to practice as a Practical OR Registered Nurse in any one of the 50 States, the District of ... ** NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** Andersen...+ Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of… more
- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... conducts initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the… more
- Tenet Healthcare (Detroit, MI)
- Registered Nurse ( RN ) - Case Manager - 2506003285 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered ... and is determined by employment status Job Description: The RN Case Manager is responsible to facilitate...management experience preferred. 3. License to practice as a Registered Nurse in the State of Michigan.… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse ( RN ) Manager , Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... + Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse ( RN ) - Active, current and… more
- Louisiana Department of State Civil Service (Kinder, LA)
- REGISTERED NURSE 1, 2, OR 3 Print...employee may be required to serve a trial detail prior to being permanently promoted + TEMPORARY JOB APPOINTMENT: This ... (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4780542) Apply REGISTERED NURSE 1, 2, OR 3 Salary...license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is… more
- Louisiana Department of State Civil Service (St. Gabriel, LA)
- REGISTERED NURSE 1, 2, OR 3 Print...employee may be required to serve a trial detail prior to being permanently promoted. + TEMPORARY JOB APPOINTMENT: This ... (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4776430) Apply REGISTERED NURSE 1, 2, OR 3 Salary Depends on Qualifications Location St.… more
- Louisiana Department of State Civil Service (Angie, LA)
- REGISTERED NURSE 1, 2 or 3 (WAE)...license, or DD-214 must be verified by official documentation prior to hire. + Any qualifying experience that is based ... Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/4777670) Apply REGISTERED NURSE 1, 2 or 3 (WAE) Salary $4,177.00 - $7,518.00 Monthly… more
- North Shore Community Health (Salem, MA)
- …opening for a Registered Nurse . Under the general direction of the Clinical Nurse Manager , the Registered Nurse will provide direct and indirect ... Registered Nurse Salem, MA (http://maps.google.com/maps?q=47+Congress+Street+Salem+MA+USA+01970) Description...when needed within the scope of nursing practice, including prior authorization forms . Provides health education… more
- Fallon Health (Worcester, MA)
- **Overview** **This is 3 months temporary contract position for a Prior Authorization RN .** **About us:** Fallon Health is a company that cares. We ... Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer preferred. * One… more
- Mayo Clinic (Jacksonville, FL)
- …Competitive retirement package to secure your future. **Responsibilities** The Registered Nurse ( RN ) Case Manager works within an interdisciplinary team ... management, care coordination, resource utilization, and clinical documentation. The RN Case Manager will function within the...entry-level associate degree registered nurses with a RN start date prior to April 1,… more
- Trinity Health (Albany, NY)
- …ass needed **What you will need:** **Required:** + A current license to practice as a Registered Nurse ( RN ) in the State of New York + Associate's degree ... **Employment Type:** Full time **Shift:** Day Shift **Description:** ** RN Care Manager (Long Term Care...well as insurance companies to manage insurance verifications and prior authorizations + Continual review and authorization … more
- CenterWell (Pink Hill, NC)
- …of Science in Nursing (BSN) strongly preferred. **License/Certifications:** + Active and unrestricted Registered Nurse ( RN ) license or Compact State RN ... sit on-site at our Kinston, NC branch location.** The ** RN Clinical Manager ** coordinates and oversees all... RN experience required; OR a combination of RN and prior LPN experience equivalent to… more
- University of Southern California (Alhambra, CA)
- …InterQual guidelines, and Medicaid/Medicare contracts and benefit systems. Required Licenses/Certifications: + Req Registered Nurse - RN (CA DCA) + Req Basic ... In collaboration with the interdisciplinary team, the Case Manager provides care coordination services evaluating options and services required to meet an… more
- Sharp HealthCare (La Mesa, CA)
- …Certified Case Manager (CCM) - Commission for Case Manager Certification; California Registered Nurse ( RN ) - CA Board of Registered Nursing ... care nursing experience or case management experience. + California Registered Nurse ( RN ) - CA...services are directed to appropriate network providers, and obtains prior authorization for in network and out… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services ... operation of the department. * Guides member through the Prior Authorization and Appeals process. * Engage...of care between settings. Required Skills and Experience * Registered nurse with current MN license and… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... from third party payers and placement to appropriate level of care prior to hospitalization utilizing medical necessity criteria and third party guidelines. Obtains… more
- Carle Health (Urbana, IL)
- …Care, Convenient Care and a wide variety of specialty clinics Under the direction of a Registered Nurse ( RN ), the Nurse Resident functions as a support ... Overview ACCEPTING APPLICATIONS 12 MONTHS PRIOR TO GRADUATION DATE Our Carle Nurse...Nursing Assistant (CNA) or Completion of first semester of Registered Nurse ( RN ) education program… more
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